Optische Kohärenztomografie in der Neurologie – Methodik und Anwendung in Forschung und Klinik

 

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Zusammenfassung

Die hochauflösende optische Kohärenztomografie (OCT) als nicht-invasives und rasch anwendbares bildgebendes Verfahren zur Untersuchung und Quantifizierung neuro-axonalen Schadens an der Netzhaut hat in den letzten Jahren zunehmend Eingang in die klinische Forschung inclusive interventioneller Studien in der Neurologie, v. a. auf dem Gebiet entzündlicher Erkrankungen, gefunden. Aktuell ist die OCT in der Lage, die Schädigung bzw. Veränderung verschiedener Netzhautschichten (z. B. der Nervenfaserschicht, der Ganglionzellschicht oder der inneren Körnerschicht) bei zahlreichen neurologischen Erkrankungen wie Optikusneuritis, Multiple Sklerose, Neuromyelitis optica, Susac-Syndrom aber auch primär neurodegenerativen Erkrankungen wie M. Parkinson, M. Alzheimer oder spinozerebellären Ataxien darzustellen. In vielen Fällen konnte eine gute Korrelation zwischen mit der OCT quantifizierter struktureller Netzhautschädigung und funktionellen visuellen Beeinträchtigungen inclusive der visuellen Lebensqualität gezeigt werden, was die klinische Relevanz der OCT-Befunde unterstreicht. Ob diese neue bildgebende Technologie Eingang in die klinische Routine-Diagnostik finden wird und für die Diagnostik und Verlaufsbeurteilung individueller Patienten geeignet ist, wird aktuell intensiv erforscht. Dieser Artikel beschreibt die Grundzüge der OCT-Technologie und die wichtigsten OCT-Befunde in Assoziation mit funktionellen Visusbefunden mit einem Schwerpunkt auf den entzündlichen Erkrankungen, für die bislang die meisten Daten vorliegen. Schließlich wird der mögliche zukünftige Einsatz in klinischen Studien und der klinischen Routine diskutiert.

Abstract

High-resolution optical coherence tomography (OCT) as a non-invasive and rapidly applicable imaging technique is being increasingly used in clinical research and interventional trials in neurology in recent years, in particular in inflammatory diseases of the CNS. OCT is capable of detecting and quantifying damage or alterations in various retinal layers (such as the retinal nerve fiber layer, the ganglion cell layer and the inner nuclear layer) in multiple neurological conditions such as optic neuritis, multiple sclerosis, neuromyelitis optica spectrum disorders, Susac syndrome and neurodegenerative disorders such as Parkinson’s disease, Alzheimer’s disease or spinocerebellar ataxias. In many studies, a good correlation between structural retinal damage measurable with OCT and functional visual impairment including visual quality of life could be demonstrated, underscoring the clinical relevance of OCT findings. Whether this technology will enter clinical routine and be found suitable for diagnosis and monitoring of individual patients with neurological conditions is a question that is currently under intensive research. This article describes the basic underpinnings of the technology, as well as the most relevant findings in various neurological disorders in relation to functional visual assessments and with an emphasis on inflammatory conditions, where most data have been gathered to date. The potential future application of OCT in clinical studies and clinical management of neurological patients is also discussed.

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